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Biomedical subjects

Heleen Beckerman

Publications and source records attributed to Heleen Beckerman.

9 recordsLinked to original sources
PubMed2006

Minimally important change determined by a visual method integrating an anchor-based and a distribution-based approach.

BACKGROUND: Minimally important changes (MIC) in scores help interpret results from health status instruments. Various distribution-based and anchor-based approaches have been proposed to assess MIC. OBJECTIVES: To describe and apply a visual method, called the anchor-based MIC distribution method, which integrates both approaches. METHOD: Using an anchor, patients are categorized as persons with an important improvement, an important deterioration, or without important change. For these three groups the distribution of the change scores on the health status instrument are depicted in a graph. We present two cut-off points for an MIC: the ROC cut-off point and the 95% limit cut-off point. RESULTS: We illustrate our anchor-based MIC distribution method determining the MIC for the Pain Intensity Numerical Rating Scale in patients with low back pain, using two conceivable definitions of minimal important change on the anchor. The graph shows the distribution of the scores of the health status instrument for the relevant categories on the anchor, and also the consequences of choosing the ROC cut-off point or the 95% limit cut-off point. DISCUSSION: The anchor-based MIC distribution method provides a general framework, applicable to all kind of anchors. This method forces researchers to choose and justify their choice of an appropriate anchor and to define minimal importance on that anchor. The MIC is not an invariable characteristic of a measurement instrument, but may depend, among other things, on the perspective from which minimal importance is considered and the baseline values on the measurement instrument under study. A balance needs to be struck between the practicality of a single MIC value and the validity of a range of MIC values.

Health Status Indicators↗
PubMed2006

Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change.

Changes in scores on health status questionnaires are difficult to interpret. Several methods to determine minimally important changes (MICs) have been proposed which can broadly be divided in distribution-based and anchor-based methods. Comparisons of these methods have led to insight into essential differences between these approaches. Some authors have tried to come to a uniform measure for the MIC, such as 0.5 standard deviation and the value of one standard error of measurement (SEM). Others have emphasized the diversity of MIC values, depending on the type of anchor, the definition of minimal importance on the anchor, and characteristics of the disease under study. A closer look makes clear that some distribution-based methods have been merely focused on minimally detectable changes. For assessing minimally important changes, anchor-based methods are preferred, as they include a definition of what is minimally important. Acknowledging the distinction between minimally detectable and minimally important changes is useful, not only to avoid confusion among MIC methods, but also to gain information on two important benchmarks on the scale of a health status measurement instrument. Appreciating the distinction, it becomes possible to judge whether the minimally detectable change of a measurement instrument is sufficiently small to detect minimally important changes.

Attitude to Health↗
PubMed2004

The value of the Rehabilitation Activities Profile (RAP) as a quality sub-system in rehabilitation medicine.

PURPOSE: To determine whether interdisciplinary team care, using the Rehabilitation Activities Profile (RAP) as a team tool, results in a better rehabilitation outcome. METHOD: A multilevel prospective cohort study, with a controlled before and after design. Eighteen rehabilitation teams in eight rehabilitation centres in the Netherlands and Belgium participated. Based on the level of implementation of the RAP, we compared three study groups. Consecutive adult patients (n = 933) with stroke, amputation of the lower limb, spinal cord injury, multiple sclerosis, or other neuromuscular disorders, were followed during inpatient or outpatient rehabilitation. Main outcome measures were Barthel Index, RAP-CPM (sum score of the domains communication, personal care and mobility), Nottingham Health Profile (NHP), length of rehabilitation (LOR) and discharge destination (home vs elsewhere). RESULTS: Overall results show that scores on the Barthel Index, the RAP-CPM and the NHP improved, on average, by 18.4%, 12.7%, and 6.7%, respectively. However, treatment from a rehabilitation team that uses the RAP was associated with a significantly lower Barthel score, and small, non-significant effects on the RAP-CPM and the NHP. Partial use of the RAP resulted in non-significant, lower scores on these measures. With respect to discharge destination and LOR, there were also no significant differences between the three study groups, with the exception of a shorter outpatient rehabilitation period for the group in which partial use was made of the RAP. CONCLUSION: The RAP, at the current level of implementation, does not improve rehabilitation outcome.

Activities of Daily Living↗
PubMed2003

How to measure comorbidity. a critical review of available methods.

The object of this article was to systematically review available methods to measure comorbidity and to assess their validity and reliability. A search was made in Medline and Embase, with the keywords comorbidity and multi-morbidity, to identify articles in which a method to measure comorbidity was described. The references of these articles were also checked, and using a standardized checklist the relevant data were extracted from these articles. An assessment was made of the content, concurrent, predictive and construct validity, and the reliability. Thirteen different methods to measure comorbidity were identified: one disease count and 12 indexes. Data on content and predictive validity were available for all measures, while data on construct validity were available for nine methods, data on concurrent validity, and interrater reliability for eight methods, and data on intrarater reliability for three methods. The Charlson Index is the most extensively studied comorbidity index for predicting mortality. The Cumulative Illness Rating Scale (CIRS) addresses all relevant body systems without using specific diagnoses. The Index of Coexisting Disease (ICED) has a two-dimensional structure, measuring disease severity and disability, which can be useful when mortality and disability are the outcomes of interest. The Kaplan Index was specifically developed for use in diabetes research. The Charlson Index, the CIRS, the ICED and the Kaplan Index are valid and reliable methods to measure comorbidity that can be used in clinical research. For the other indexes, insufficient data on the clinimetric properties are available.

Comorbidity↗
PubMed2002

Treating patients with hemiplegic shoulder pain.

Studies on the efficacy of available methods of treatment for hemiplegic shoulder pain are reviewed in an attempt to identify the most effective treatment for this problem. Because of the poor quality of the 14 selected studies, no definite conclusion can be drawn about the most effective method of treatment. However, functional electrical stimulation and intra-articular triamcinolone acetonide injections seem to be the most promising treatment options.

Biofeedback, Psychology↗
PubMed2002

Development and implementation of the Rehabilitation Activities Profile for children: impact on the rehabilitation team.

OBJECTIVE: To describe the changes in functioning of the rehabilitation team induced by the Rehabilitation Activities Profile for children (Children's RAP), an instrument designed to improve interdisciplinary communication in paediatric rehabilitation. DESIGN: Multiple case-study design. SUBJECTS: Seven paediatric rehabilitation teams. INTERVENTION: A two-year project to develop and implement the Children's RAP. DATA COLLECTION: During the project, data were gathered from observations, documents and informal interviews. After the project, formal interviews were held with team members and parents, and a focus group meeting with representatives of the teams was organized. DATA ANALYSIS: Data were analysed by the method of analytic induction. The analysis was checked by an independent researcher. The preliminary results and conclusions were discussed in detail with participating teams. RESULTS: Development and implementation, as well as the changes induced by the project, varied between teams. Changes were observed for individual team members, for the team as a whole and for the children and their parents. However, changes for individual team members occurred relatively quickly, in comparison with the other changes. To achieve an optimal interdisciplinary team approach all changes are necessary. Therefore, we postulated four hierarchical steps in the development of an interdisciplinary team approach: (1) process-oriented approach, (2) result-oriented approach, (3) problem-oriented approach, and (4) interdisciplinary team approach. CONCLUSION: It took a considerable amount of time to achieve the interdisciplinary team approach by implementing the Children's RAP. However, the first steps are not only rewarding in themselves, but also prerequisites for further improvement.

Adolescent↗
PubMed2002

Improving the Action Research Arm test: a unidimensional hierarchical scale.

BACKGROUND: The Action Research Arm (ARA) test is a performance test of upper extremity motor function which consists of 19 items divided into four hierarchical subtests. This multidimensionality has not yet been tested empirically. OBJECTIVE: To investigate the dimensionality of the ARA test. DESIGN: Cross-sectional study involving a sample of 63 chronic stroke patients. METHODS: A Mokken scale analysis was performed. RESULTS: The Mokken scale analysis revealed one strong unidimensional scale containing all 19 items, of which the scalability coefficient H was 0.79, while H per item ranged from 0.69 to 0.86. The reliability coefficient rho equalled 0.98, indicating a very high internal consistency. A subset of 15 out of 19 items showed an invariant hierarchical item-ordering. CONCLUSION: The ARA test is a unidimensional scale. The use of subtests, as proposed in the original description of the instrument, is not supported by the present findings. The 15-item scale presented here can be used for adaptive testing, i.e. using only a selected subset of items based on prior knowledge about the patient's abilities, thus minimizing testing time.

Aged↗